With later recognition of the importance of the patient perspective, and of the poor correlation between lung function and inflammation and symptoms (3, 4), clinical trials and clinical practice have increasingly focused on the assessment of “asthma control.” This is a summary term that implies a global assessment of symptoms, reliever use, lung function, and the frequency/severity of exacerbations. Travers J, Marsh S, Aldington S, Williams M, Shirtcliffe P, Pritchard A, Weatherall M, Beasley R. Reference ranges for exhaled nitric oxide derived from a random community survey of adults. ‡‡Biomarkers (e.g., sputum eosinophils, sputum neutrophils, exhaled nitric oxide) are markers of underlying disease activity, and the extent to which this has been modified by treatment. Many markers of airway inflammation have been reported in EBC. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. Standardised methodology of sputum induction and processing. Challenge tests for AHR in children with asthma require satisfactory cooperation with spirometry. Percent predicted values should not be used as outcome variables (139), except as above in long-term pediatric studies. “Well-controlled” asthma weeks and “Total Control” weeks. The Cochrane Register of Randomized Controlled Trials was searched for all studies published between 1998 and 2004 that contained the words “asthma control,” “asthma severity,” or “asthma exacerbation(s).” This yielded 440 references, decreasing to 356 after exclusion of non–English-language references and those published only as abstracts, and to 327 after exclusion of duplicates. An ATAQ for children and adolescents (range, 0–7) has been developed (251). Reporting group mean differences for individual symptom scores may be better in such populations. Clinical comparison of fenoterol and albuterol administered by inhalation: a double-blind study. Changes in peak flow, symptom score, and the use of medications during acute exacerbations of asthma. Reddel HK. Symptoms and airway obstruction are integral to the definition of asthma, and represent important components of the assessment of asthma control in clinical practice and clinical trials. Reddel HK, Vincent SD, Civitico J. Monitoring asthma. There are multiple different calculations of within-day variability (diurnal variability) (127), but the most common is amplitude percent mean (day's highest minus lowest/mean), averaged over 7 days. The 1993 ERS and 1999 ATS standardized methods should be used. Adult subjects with moderate-severe asthma were evaluated at baseline and 3-month follow-up. Questionnaires with substantial validation data are summarized below, and more detail is provided in Table E4. Pediatric and Primary Care Working Groups provided specialized perspective on the recommendations from each Working Group (see Working Group Membership). Effect of salmeterol compared with beclomethasone on allergen-induced asthmatic and inflammatory responses. Pifferi M, Baldini G, Marrazzini G, Baldini M, Ragazzo V, Pietrobelli A, Boner AL. Asthma is characterized by variable airflow limitation, so, as expected, the visit-to-visit reproducibility of FEV1 (without an intervention) is significantly better in healthy subjects than in asthma (146). Analysis of data drawn from over the whole treatment period will reflect the magnitude and rate of treatment response, the extent of variation in level of control, and the occurrence of exacerbations, all of which are relevant to the overall impact of treatment on asthma control. Influence of treatment on peak expiratory flow and its relation to airway hyperresponsiveness and symptoms. †In general, it is preferable to record the level of asthma control throughout the study rather than just at the end of the treatment period. Leuppi JD, Salome CM, Jenkins CR, Anderson SD, Xuan W, Marks GB, Koskela H, Brannan JD, Freed R, Andersson M. O'Connor GT, Sparrow D, Weiss ST. A prospective longitudinal study of methacholine airway responsiveness as a predictor of pulmonary function decline: the Normative Aging Study.
FeNO measurements provide easily obtained information on underlying disease activity where it is characterized by eosinophilic airway inflammation, but the positive and negative predictive values for eosinophilia are suboptimal. As described in methodology, the Task Force recommendations are based on the definitions of asthma and asthma control, the dual emphasis on optimizing current control and minimizing future risk, and the measurement properties and feasibility of each measure. Booth H, Richmond I, Ward C, Gardiner PV, Harkawat R, Walters EH. However, even in patients thought to have mild asthma, the rates of severe asthma exacerbations have been much higher than expected (15, 16). A full and detailed accounting of quantifiable costs is required to reflect the economic impact of poor control and of therapeutic interventions. Existing composite measures have primarily been validated against physician judgment or other measures of current clinical control without weighting of their components. (Ah bon, c’est donc vrai). The primary perspective for the assessment of asthma control is that of the patient.
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